margaret fahy
Guru
Hi Everyone,
Anyone feel like tackling this one? The diagnostic angios are what get me....
Tentatively I have.....Right side-36226 (subclavian also done but dr. said she did inject into vertebral), 36223, 36227, and....Left side....36226, 36223.....then the intervention....61624, 75894, and 75898 X3....what do you think?....Thanks in advance.....
PROCEDURE: Cerebral Angiogram and embolization of multiple
feeders supplying C1 neoplasm
HISTORY: 16 year old male for preoperative embolization of C1
neoplasm possible osteoblastoma.
VESSELS SELECTED:
Right subclavian artery
Right deep cervical artery
Right vertebral artery
Right common carotid artery
Right external carotid artery
Right occipital artery
Left common carotid artery
Left vertebral artery
COMPLICATIONS: None.
TECHNIQUE:
After informed consent the patient was brought into the
angiography suite and placed supine on the angiographic table.
The right groin was prepped and draped using sterile technique.
The skin overlying the right femoral artery was locally
anesthetized with Sensorcaine. Ultrasound guidance was used to
evaluate the right groin site and patency of the right femoral
artery was noted. Using standard micropuncture kit with
ultrasound guidance under realtime visualization the
micropuncture needle was advanced into the right femoral artery.
The right femoral artery was accessed and a 6-French sheath was
placed. Using an 0.038" angled Glide Wire and 6-French Envoy
catheter, the vessels detailed above were selectively
catheterized for angiography.
FINDINGS:
RIGHT COMMON CAROTID, EXTERNAL CAROTID, OCCIPITAL ARTERY
INJECTION, NECK VIEWS: There is a large amount of supply to the
vascular lesion through proximal occipital artery branch feeders
and distal deep cervical artery feeders. Otherwise, unremarkable
angiographic appearance of the visualized right internal and
external carotid arteries. No evidence of aneurysm, high grade
focal intracranial stenosis, or vascular malformation.
LEFT COMMON CAROTID ARTERY INJECTION, NECK VIEWS: There is a
small amount of supply to the vascular lesion via tiny proximal
occipital artery branches. Otherwise, unremarkable angiographic
appearance of the visualized right internal and external carotid
arteries. No evidence of aneurysm, high grade focal intracranial
stenosis, or vascular malformation.
RIGHT VERTEBRAL ARTERY INJECTION, NECK VIEWS: There is retrograde
flow into the left vertebral artery which supplies a large
portion of the vascular tumor. Otherwise, unremarkable
angiographic appearance of the distal right vertebral artery,
right posterior inferior cerebellar artery, vertebrobasilar
junction, as well as the basilar artery and its visualized
branches. The angiogram has normal parenchymal and venous phases.
No evidence of aneurysm, high grade focal intracranial stenosis,
or vascular malformation.
LEFT VERTEBRAL ARTERY INJECTION, NECK VIEWS: A branch feeder from
the mid V3 vertebral artery supplies a large portion of the
vascular tumor. Otherwise, unremarkable angiographic appearance
of the left posterior inferior cerebellar artery, vertebrobasilar
junction, as well as the basilar artery and its visualized
branches. The angiogram has normal parenchymal and venous phases.
No evidence of aneurysm, high grade focal intracranial stenosis,
or vascular malformation.
An intervention was performed as follows.
INTERVENTION:
Utilizing a 0.035" Glide Wire, the 6-French Envoy catheter was
navigated into the proximal aspect of the right deep cervical
artery. Utilizing a Synchro-2 microwire, a SL-10 microcatheter
was advanced distally into the deep cervical artery supplying the
vascular tumor. 250-355 micron particles were prepped in standard
fashion and pulse injected into the deep cervical artery until
stasis of flow was achieved. Post embolization angiography
demonstrated near complete obliteration of flow to the vascular
tumor.
The 6-French Envoy catheter was then navigated into the right
external carotid artery. Utilizing a Synchro-2 microwire, a SL-10
microcatheter was advanced into the proximal right occipital
artery branch supplying the vascular tumor. Pre-embolization
angiography demonstrated exclusive supply to the tumor without
evidence of a spinal artery or collateral vessels to the
posterior circulation. 250-355 micrometer particles were prepped
in standard fashion and pulse injected into the branch feeder
until stasis of flow was achieved. Post embolization angiography
demonstrated minimal residual vascular blush remaining within the
tumor bed.
The 6-French Envoy catheter was finally navigated into the
proximal left vertebral artery. Utilizing a Synchro-2 microwire,
a SL-10 microcatheter was advanced into a branch feeder from the
V3 vertebral artery supplying the vascular tumor. 150-250
micrometer particles were prepped in standard fashion and pulse
injected into the branch feeder until stasis of flow was
achieved. Post embolization angiography demonstrated minimal
residual vascular blush remaining within the tumor bed.
The parent and branch arteries were widely patent on final
angiography, otherwise unchanged in appearance in comparison to
pre-embolization imaging.
At the completion of the procedure, the catheter and sheath were
removed and stasis of flow was achieved after 20 minutes of
manual pressure.
No new neurological deficits or complications were encountered
during or immediately following the procedure.
IMPRESSION
Successful particle embolization of branch feeders from the right
deep cervical artery, right occipital artery, and left vertebral
artery supplying the vascular lesion. There is minimal residual
vascularity remaining from the embolized branch vessels on post
embolization angiography.
Drs. were present during the whole procedure and
are personally responsible for its interpretation.
Anyone feel like tackling this one? The diagnostic angios are what get me....
Tentatively I have.....Right side-36226 (subclavian also done but dr. said she did inject into vertebral), 36223, 36227, and....Left side....36226, 36223.....then the intervention....61624, 75894, and 75898 X3....what do you think?....Thanks in advance.....
PROCEDURE: Cerebral Angiogram and embolization of multiple
feeders supplying C1 neoplasm
HISTORY: 16 year old male for preoperative embolization of C1
neoplasm possible osteoblastoma.
VESSELS SELECTED:
Right subclavian artery
Right deep cervical artery
Right vertebral artery
Right common carotid artery
Right external carotid artery
Right occipital artery
Left common carotid artery
Left vertebral artery
COMPLICATIONS: None.
TECHNIQUE:
After informed consent the patient was brought into the
angiography suite and placed supine on the angiographic table.
The right groin was prepped and draped using sterile technique.
The skin overlying the right femoral artery was locally
anesthetized with Sensorcaine. Ultrasound guidance was used to
evaluate the right groin site and patency of the right femoral
artery was noted. Using standard micropuncture kit with
ultrasound guidance under realtime visualization the
micropuncture needle was advanced into the right femoral artery.
The right femoral artery was accessed and a 6-French sheath was
placed. Using an 0.038" angled Glide Wire and 6-French Envoy
catheter, the vessels detailed above were selectively
catheterized for angiography.
FINDINGS:
RIGHT COMMON CAROTID, EXTERNAL CAROTID, OCCIPITAL ARTERY
INJECTION, NECK VIEWS: There is a large amount of supply to the
vascular lesion through proximal occipital artery branch feeders
and distal deep cervical artery feeders. Otherwise, unremarkable
angiographic appearance of the visualized right internal and
external carotid arteries. No evidence of aneurysm, high grade
focal intracranial stenosis, or vascular malformation.
LEFT COMMON CAROTID ARTERY INJECTION, NECK VIEWS: There is a
small amount of supply to the vascular lesion via tiny proximal
occipital artery branches. Otherwise, unremarkable angiographic
appearance of the visualized right internal and external carotid
arteries. No evidence of aneurysm, high grade focal intracranial
stenosis, or vascular malformation.
RIGHT VERTEBRAL ARTERY INJECTION, NECK VIEWS: There is retrograde
flow into the left vertebral artery which supplies a large
portion of the vascular tumor. Otherwise, unremarkable
angiographic appearance of the distal right vertebral artery,
right posterior inferior cerebellar artery, vertebrobasilar
junction, as well as the basilar artery and its visualized
branches. The angiogram has normal parenchymal and venous phases.
No evidence of aneurysm, high grade focal intracranial stenosis,
or vascular malformation.
LEFT VERTEBRAL ARTERY INJECTION, NECK VIEWS: A branch feeder from
the mid V3 vertebral artery supplies a large portion of the
vascular tumor. Otherwise, unremarkable angiographic appearance
of the left posterior inferior cerebellar artery, vertebrobasilar
junction, as well as the basilar artery and its visualized
branches. The angiogram has normal parenchymal and venous phases.
No evidence of aneurysm, high grade focal intracranial stenosis,
or vascular malformation.
An intervention was performed as follows.
INTERVENTION:
Utilizing a 0.035" Glide Wire, the 6-French Envoy catheter was
navigated into the proximal aspect of the right deep cervical
artery. Utilizing a Synchro-2 microwire, a SL-10 microcatheter
was advanced distally into the deep cervical artery supplying the
vascular tumor. 250-355 micron particles were prepped in standard
fashion and pulse injected into the deep cervical artery until
stasis of flow was achieved. Post embolization angiography
demonstrated near complete obliteration of flow to the vascular
tumor.
The 6-French Envoy catheter was then navigated into the right
external carotid artery. Utilizing a Synchro-2 microwire, a SL-10
microcatheter was advanced into the proximal right occipital
artery branch supplying the vascular tumor. Pre-embolization
angiography demonstrated exclusive supply to the tumor without
evidence of a spinal artery or collateral vessels to the
posterior circulation. 250-355 micrometer particles were prepped
in standard fashion and pulse injected into the branch feeder
until stasis of flow was achieved. Post embolization angiography
demonstrated minimal residual vascular blush remaining within the
tumor bed.
The 6-French Envoy catheter was finally navigated into the
proximal left vertebral artery. Utilizing a Synchro-2 microwire,
a SL-10 microcatheter was advanced into a branch feeder from the
V3 vertebral artery supplying the vascular tumor. 150-250
micrometer particles were prepped in standard fashion and pulse
injected into the branch feeder until stasis of flow was
achieved. Post embolization angiography demonstrated minimal
residual vascular blush remaining within the tumor bed.
The parent and branch arteries were widely patent on final
angiography, otherwise unchanged in appearance in comparison to
pre-embolization imaging.
At the completion of the procedure, the catheter and sheath were
removed and stasis of flow was achieved after 20 minutes of
manual pressure.
No new neurological deficits or complications were encountered
during or immediately following the procedure.
IMPRESSION
Successful particle embolization of branch feeders from the right
deep cervical artery, right occipital artery, and left vertebral
artery supplying the vascular lesion. There is minimal residual
vascularity remaining from the embolized branch vessels on post
embolization angiography.
Drs. were present during the whole procedure and
are personally responsible for its interpretation.
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